- House Speaker Paul Ryan (R-Wis.) has suggested that as the new Donald Trump administration prepares to replace the ACA come January 20, it will also need to consider overhauling Medicare due to “serious problems” with the program.
- Ryan, who has long advocated entitlement reform, appears eager to take the upcoming evisceration of the ACA as an opening to lump Medicare and Medicaid in with the healthcare law due to the programs having been impacted by ACA provisions.
- It's unclear whether Ryan will have the support of the GOP and/or Trump, who has previously called Medicare a program that has worked and that "some people love," The Washington Post reported.
The first question is whether other Republicans will share Ryan's gusto for going after Medicare and taking on the political risk that entails, which could include going against whatever position Trump takes.
Beyond that is the matter of how to take Ryan's argument that Medicare is broke and that its problems are due to impacts of the ACA, which critics argue is false. Even if Ryan is successful in leading a GOP charge against Medicare, there would remain the question of what that would actually achieve after shifting more healthcare costs onto seniors and accepting the ramifications that would come with that.
"When Obamacare became Obamacare, Obamacare rewrote Medicare, rewrote Medicaid, so if you’re going to repeal and replace Obamacare, you have to address those issues as well,” Ryan told Fox News. “What people don’t realize is that Medicare is going broke, that Medicare is going to have price controls. Because of Obamacare, Medicaid is in fiscal straits. So you have to deal with those issues if you’re going to repeal and replace Obamacare.”
A new version of the “Better Way” policy package Ryan headed earlier this year may be expected along with other House Republicans that proposed a variety of reforms, the Post noted. Those included repealing the Independent Payment Advisory Board (IPAB), created under the ACA and set to go into effect next year, to recommend cuts in federal Medicare payments. The package also looked at expanding Medicare Advantage, which is operated by private insurers, as well as the more radical idea of replacing Medicare with a “premium support” system to help seniors pay for private plans.
Ryan's characterization of Medicare as being "broke" and damaged by the ACA have been countered by publications including the Post, arguing those claims are "doubly wrong" in that Congress can protect the Part A trust fund--the only portion projected for depletion--from going bankrupt as it has before, and that positive impacts of the ACA are responsible for extending Medicare's “insolvency” date by 12 years.